Dr. Decipher: The Dr. is In, But Make It Quick

August 31st, 2009 by WY Daily Staff

Dr. Decipher: The Dr. is In, But Make It Quick

Have you ever felt rushed at a doctor’s visit?  Have you been in an office or hospital and felt more like a statistic than a patient?  Have you ever been given a diagnosis or had a test performed yet you did not understand it fully?

I believe people are most unhappy with healthcare not because it costs too much (it does), but because they don’t feel they are treated with the time, respect, and caring that they deserve.

Dr. Peter Salgo wrote in a NY Times Op-Ed in 2006 that there has been a change in attitude in healthcare. While it has become more business like, the doctor-patient relationship has suffered tremendously.

The face-to-face time physicians spend with each patient in a primary care setting has been studied.  It is around 7-12 minutes (in both the US and UK), but many patients feel that they need more time. Patient dissatisfaction has been correlated with less compliance with medication use and a reluctance to follow the doctor’s advice.

Physicians feel like hamsters on a wheel, continuously running to try to see more patients faster while the federal government (Medicare and Medicaid) and insurance companies throw speedbumps in front of us such as more billing documentation requirements, pay for performance guidelines, and electronic medical record requirements while simultaneously giving lower reimbursements.  All the while malpractice premiums continue to rise.

According to Ian Morrison PhD in the Future of Physicians’ Time the hamster effect is even worse in Germany and Canada due to the fixed budget, standardized fee schedule and limits on total income.

We spend more time sitting in front of our computers than our patients. Physicians, especially those of us in our middle-aged years (who have become accustomed to longer visits) value the time we spend alone speaking with patients and their families. This time is golden and must be preserved and protected.

Lawyers get paid by the hour for their time. A boat mechanic recently charged me a huge amount per hour for service, I told him that I didn’t make as much and he replied, “I know, I used to be a doctor!” (haha).

A new and growing industry is concierge medicine where doctors provide comprehensive care for affluent patients who pay in cash. Is this what it takes to get personalized care?

The new business buzzwords for patients are: “customers,” “consumers,” and “clients”.  Hospitals talk about “length of stay”, “through put”  “right sizing”, and “resources”.

While physician practices and hospitals must strive to run efficiently and should adopt sound business practices, healthcare, because of its inherently humanistic and compassionate nature is different from other businesses.  Taking your mother to a hospital for a kidney transplant is much different than taking your car to the mechanic for a new transmission.

Healthcare is about patients. It is about caring.  It is not just procedures and technology and data. Medicine is more of an art than a science. For example, if treating high blood pressure was straightforward then one could just put his arm into a computerized sphygmomanometer machine at the pharmacy for several days, then receive automatically dispensed pills.

A young woman with a headache came into my office. Within a couple of minutes, it was obvious that it was not an acutely serious problem.  Only after a long talk about her family and concerns did she reveal her true concern: her mother had died of brain cancer and that is what she feared most. Only then I was able to alleviate her fears with low tech counseling instead of high tech testing.

We need more emphasis on compassion and treating the whole person. This requires more and better communications between providers and patients with the realization that much of healthcare should be devoted to educating patients and helping them deal with their illnesses. We must also address prevention including socioeconomic and psychosocial issues. Why prescribe an $80 antibiotic or blood pressure pill when one from the Wal Mart $4 list will do?

There’s all kinds of talk about healthcare; let’s get back to what is really important in medicine. The late Dr. Philip A.Tumulty, professor emeritus at Johns Hopkins wrote, “time personally spent with the patient is the most essential ingredient of excellence in clinical practice…there must be time for the patient to communicate himself to you, and you to him.  Without adequate time, you cannot possibly give sufficiently of yourself to your patients. Time is what they expect and what they need.”

Disclaimer: This does not take the place of regular medical care, and is not a complete review of any medical conditions. Consult with a physician before any treatment or taking any medications. Seek medical attention immediately for any serious symptoms, or call 911. No current or local patients have been referenced, so any resemblance is purely coincidental.

One Response to Dr. Decipher: The Dr. is In, But Make It Quick

  1. Anonymous

    August 31, 2009 at 11:57 am

    Dr. Janousek describes very well what is really important in medicine. I’m happy to say that since we’ve moved to Williamsburg my wife and I have received exactly that kind of care from our primary care physician, from the specialists we’ve also seen, and from our dentist. I particularly commend and thank Dr. Blanchard, PA Ms. Kraut-Cole, Dr. Keller, Dr. Jacobson, and Dr. Fuller for their excellent care and consideration.

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